THE EXPERIENCES OF OLDER ADULTS WITH CANCER IN MANAGING HYPERTENSION AS A COMORBIDITY DURING END OF LIFE CARE

Alexander Alexander; Nunung Febriany Sitepu; Dian Azhari

doi:10.22437/7vbk7184

Penulis

Alexander Alexander Master of Nursing Science, Faculty of Medicine, Public Health, and Nursing, Gadjah Mada University, Yogyakarta, Indonesia. https://orcid.org/0009-0003-5725-8766 (tidak diautentikasi)
Nunung Febriany Sitepu University of Sumatera Utara
Dian Azhari University of Sumatera Utara

DOI:

https://doi.org/10.22437/7vbk7184

Kata Kunci:

End of life care, Geriatric Oncology, Hypertension, Palliative Nursing

Abstrak

Managing comorbidities such as hypertension in geriatric cancer patients during end-of-life care presents a profound clinical and psychological dilemma, as treatment goals shift from strict physiological control to comfort. This study aimed to deeply explore the authentic lived experiences of older adults with advanced cancer in managing hypertension as a comorbidity during their end-of-life care phase. A qualitative descriptive phenomenological approach was conducted. Purposive sampling was used to recruit eight geriatric cancer patients (aged ≥60 years) with a documented history of comorbid hypertension who were currently receiving palliative or end-of-life care in East Java, Indonesia. Semi-structured, face-to-face in-depth interviews were carried out over a six-month period. The qualitative data were transcribed verbatim and analyzed systematically using Colaizzi’s seven-step phenomenological method to maintain structural rigor. The study successfully identified three main themes: (1) The Burden of Dual Illness: navigating the physical overlap of cancer pain and hypertensive distress; (2) The Treatment Dilemma: patient and family perceptions regarding the necessity of anti-hypertensive polypharmacy versus palliative comfort; and (3) Seeking a Peaceful Death: balancing existential acceptance with the daily stress of physiological monitoring. The study contributes an experiential perspective on how older adults negotiate cardiovascular management, treatment burden, autonomy, and psychospiritual priorities when hypertension coexists with advanced cancer at the end of life. These findings support flexible, individualized, comfort-oriented palliative nursing care that integrates symptom relief, medication review, shared decision-making, and patients’ cultural and spiritual values.

Biografi Penulis

Alexander Alexander, Master of Nursing Science, Faculty of Medicine, Public Health, and Nursing, Gadjah Mada University, Yogyakarta, Indonesia.

Master of Nursing Science, Faculty of Medicine, Public Health, and Nursing, Gadjah Mada University, Yogyakarta, Indonesia.
Nunung Febriany Sitepu, University of Sumatera Utara

Department of Medical-surgical Nursing, Faculty of Nursing, University of Sumatera Utara
Dian Azhari, University of Sumatera Utara

Department of Nursing Science, Faculty of Nursing, University of Sumatera Utara

Referensi

1. Aisyah, S., Suza, D.E. and Tarigan, R., 2021. Kebutuhan spiritual pada lansia dengan penyakit kronis di komunitas. Jurnal Keperawatan Klinis, 9(1), pp.34–42.

2. Bakitas, M.A., Tosteson, T.D., Li, Z., Lyons, K.D., Hull, J.G., Li, Z., Dionne-Odom, J.N., Frost, J., Azuero, A. and Hegedus, P., 2015. Early versus delayed initiation of concurrent palliative care for patients with advanced cancer: particles of course (ENABLE III) randomized controlled trial. Journal of Clinical Oncology, 33(13), pp.1438–1445.

3. Cassell, E.J., 2004. The nature of suffering and the goals of medicine. Oxford: Oxford University Press.

4. Charalambous, A., Katajisto, J., Välimäki, M., Leino-Kilpi, H. and Suhonen, R., 2016. Individualised care and the quality of life of oncological patients. European Journal of Oncology Nursing, 22, pp.30–37.

5. Colaizzi, P.F., 1978. Psychological research as the phenomenologist views it. In: Valle, R.S. and King, M. eds. Existential-phenomenological alternatives for psychology. New York: Oxford University Press, pp.48–71.

6. Effendy, C., Vissers, K., Osse, B.H., Tejawinata, S., Vernooij-Dassen, M. and Engels, Y., 2015. Comparison of problems and unmet needs of advanced cancer patients and their family caregivers in Indonesia. Supportive Care in Cancer, 23(3), pp.843–852.

7. Hasanah, M., Nursalam, N. and Pradanie, R., 2023. Kompetensi perawat dalam asuhan keperawatan paliatif pada lansia dengan penyakit terminal: A systematic review. Jurnal Keperawatan Klinis dan Komunitas, 7(2), pp.112–121.

8. Husserl, E., 2012. Ideas: general introduction to pure phenomenology. Translated by W.R. Boyce Gibson. London: Routledge.

9. Indarwati, R., Latif, N. and Sukartini, T., 2020. Analisis koping keluarga dalam merawat lansia dengan penyakit kronis stadium lanjut. Jurnal Keperawatan Gerontologi, 4(2), pp.88–95.

10. Krisnawati, D., Suhartini, S. and Hikayati, H., 2022. Hambatan komunikasi terapeutik perawat pada pasien kanker fase akhir hayat. Caring: Jurnal Keperawatan, 11(2), pp.76–84.

11. Kurnia, A.D., Amatayakul, A., Karuncharernpanit, S. and Keeratiyutawong, P., 2018. Predictors of quality of life among Indonesian cervical cancer survivors in the palliative phase. Indonesian Journal of Cancer, 12(4), pp.98–105.

12. Morrow, R., Rodriguez, A. and King, N., 2015. Colaizzi’s descriptive phenomenological method. The Humanistic Psychologist, 43(1), pp.64–69.

13. Moser, A. and Korstjens, I., 2018. Series: Practical guidance to qualitative research. Part 3: Sampling, data collection and analysis. European Journal of General Practice, 24(1), pp.9–18.

14. Nursalam, N., Sukartini, T., Priyantini, S. and Solikhah, F.K., 2022. Development of a supportive-educative nursing intervention model based on family centered care for quality of life in geriatric chronic illness. Journal of Pakistan Medical Association, 72(2), pp.124–129.

15. Papadopoulos, K.P., Fontes, M.S.N., Shord, S.S., Desai, A. and George, S., 2020. Hypertension in older adults receiving chemotherapy and targeted therapies for advanced malignancies. Drugs & Aging, 37(8), pp.553–567.

16. Pradanie, R., Hasanah, M. and Nursalam, N., 2024. Pendidikan kesehatan paliatif berbasis keluarga untuk meningkatkan efisiensi perawatan lansia kanker di rumah. Jurnal Ilmiah Keperawatan, 15(1), pp.12–21.

17. Rochmawati, E., Wiechula, R. and Barton, C., 2016. Palliative care needs of patients with advanced cancer in Indonesia: A qualitative study. European Journal of Oncology Nursing, 23, pp.9–14.

18. Rochmawati, E., Wiechula, R. and Barton, C., 2018. Understanding the models of palliative care delivery in Indonesia: A qualitative study. International Journal of Palliative Nursing, 24(11), pp.553–561.

19. Roth, W.M. and Jornet, A., 2014. Toward a theory of experience. Science Education, 98(1), pp.106–126.

20. Santoso, B., Suhartini, S. and Krisnawati, D., 2023. Persepsi keluarga mengenai de-medikalisasi pada perawatan akhir hayat lansia kanker. Jurnal Keperawatan Klinis, 11(3), pp.145–154.

21. Saunders, B., Sim, J., Kingstone, T., Baker, S., Waterfield, J., Bartlam, B., Burroughs, H. and Jinks, C., 2018. Saturation in qualitative research: exploring its conceptualization and operationalization. Quality & Quantity, 52(4), pp.1893–1907.

22. Setyawati, A., Setyabudi, M.T., Utami, R.S. and Hariyati, R.T.S., 2020. Cardiovascular risk monitoring and nurse workload in clinical oncology settings. Enfermería Clínica, 30(5), pp.211–215.

23. Smeltzer, S.C., Bare, B.G., Hinkle, J.L. and Cheever, K.H., 2010. Brunner & Suddarth's textbook of medical-surgical nursing. 12th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

24. Sukartini, T., Solikhah, F.K. and Nursalam, N., 2021. Pengaruh perawatan paliatif berbasis komunitas terhadap kenyamanan spiritual lansia penderita penyakit terminal. Jurnal Keperawatan Klinis dan Komunitas, 5(2), pp.67–75.

25. Suhartini, S., Krisnawati, D. and Hikayati, H., 2021. Pengalaman perawat dalam manajemen nyeri paliatif pada pasien kanker lanjut usia. Caring: Jurnal Keperawatan, 10(1), pp.45–54.

26. Suza, D.E., Tarigan, R., Ginting, R. and Ismayadi, I., 2020. Lived experiences of elderly cancer patients under palliative care in North Sumatra. Open Access Macedonian Journal of Medical Sciences, 8(T2), pp.184–189.

27. Tarigan, R., Ginting, R. and Suza, D.E., 2022. Analisis beban pengasuhan keluarga pada lansia dengan kanker stadium lanjut yang dirawat di rumah. Jurnal Keperawatan Terpadu, 14(1), pp.45–53.

28. Utami, R.S., Hariyati, R.T.S. and Setyawati, A., 2019. Beban obat polifarmasi pada lansia dengan penyakit penyerta kronis di ruang rawat akut. Jurnal Keperawatan Indonesia, 22(3), pp.190–198.

29. Wijayanti, L., Indarwati, R. and Sukartini, T., 2023. Hubungan antara status kognitif lansia kanker dengan kemampuan pengambilan keputusan klinis bersama. Jurnal Keperawatan Gerontologi, 7(1), pp.23–31.

30. Yodang, Y. and Rochmawati, E., 2021. Palliative care education in Indonesian nursing curricula: A review of national guidelines. Belitung Nursing Journal, 7(4), pp.265–272.